- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,655.05 / $3,772.57 / $8,074.63
| Facility | | $1,655.05 | $3,772.57 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,475.89 / $1,721.85 / $2,704.46
| Professional | | $1,475.89 | $1,721.85 | $2,704.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,329.50 / $16,401.00 / $29,216.95
| Facility | | $8,329.50 | $16,401.00 | $29,216.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,615.00 / $2,084.52 / $3,322.26
| Professional | | $1,615.00 | $2,084.52 | $3,322.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,893.14 / $1,893.14 / $2,651.08
| Facility | | $1,893.14 | $1,893.14 | $2,651.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,664.21 / $2,436.87 / $3,952.29
| Professional | | $1,664.21 | $2,436.87 | $3,952.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,655.81 / $2,229.08 / $4,110.10
| Professional | | $1,655.81 | $2,229.08 | $4,110.10 |